Borrower Card Form | Eastside Funding

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Eastside Funding is requesting this information to comply with the reporting requirement of the Home Mortgage Disclosure Act (HMDA).
Is there a co-borrower?
- Yes
- No
Borrower Name*
Co-Borrower Name*
Company Name (if applicable)
Company EIN (if applicable)
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Borrower DOB
MM slash DD slash YYYY
Co-Borrower DOB
MM slash DD slash YYYY
Borrower Email
Co-Borrower Email
Borrower Phone
Co-Borrower Phone
Borrower Gender
Co-Borrower Gender
Borrower Ethnicity
Co-Borrower Ethnicity
Borrower Race
Co-Borrower Race

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